WARCA

Courses Enquiries

Student Enrolment Form

You are enrolling in a Joondalup Sorting Out My Toolbox

Course Start date: 25 Mar 2021

Please fill in the Registration form below. Fields with a red * are required.

Student Details

Your Details

First Name *

Surname *

Preferred Name

Gender *

Date of Birth *

Email *

Mobile *

Home Phone

Can we leave a message (voice or text) on the above numbers? *

Yes

No

How else might we contact you?

Your Address

Unit No

Street No *

Street Name *

Town/Suburb *

Postcode *

State/Territory *

Emergency Contact

First Name *

Surname *

Phone/Mobile *

Relationship to Student *

Address *

How else might we contact your emergency contact?

Is your emergency contact aware that they have been nominated for this purpose? *

Yes

No

Enrolment Details

Country of Birth *

Year of arrival in Australia

Languages spoken at home

Do you require an interpreter?

Yes

No

Do you identify as: *

We would like to understand the experience our students bring in relation to mental health and/or alcohol and drug challenges. You may have experienced these yourself, have supported someone or have professional experience. (Please tick all below that apply) *

Own experience

Supported a friend

Supported a family member

Carer

Mental Health Worker

Alcohol and Other Drug Worker

Prefer to not say

None

Prefer to self-describe:

Other:

Which is your highest level of education? *

Which of the following would best describe your current work status? *

Please give details of any particular supports you may require to fully participate in this course:

Supports could include one or more of the following (please tick all that apply) *

Language, literacy and numeracy support, e.g. computer literacy

Disability support, e.g. access and equity for blind students

Cultural or community support, e.g. linking students with a buddy

Interpreting Services for culturally and linguistically diverse students

Technology requirements for remote students, e.g. teleconferencing or Zoom meeting

Not applicable

How would you describe your reason for attending? *

What would you like to get out of this course? *

Privacy Notice

Privacy Notice

Western Australian Recovery College Alliance complies with the Privacy Act of 1988.
Your information is used to assist you in your learning needs and evaluation of the program.
Your information will be stored on the WARCA Record Management System.

I have read and I agree to the Privacy Notice. *

Parent/Guardian acknowledgment and consent. *

Finalise

How did you hear about us? *

The WA Recovery College Alliance is interested in whether this course has had a long term benefit on your recovery and well being. Would you be interested in participating in a follow up survey in 12-18 months? *

Yes

No

This box must be ticked before you can submit the form.

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